Four patients are described in whom pneumoconiosis was diagnosed towards the end of a lifetime's work in shale mines. All developed complicated pneumoconiosis, diagnosed in two cases at necropsy, in one by lobectomy, and in one radiologically. Two of the patients were found at necropsy also to have peripheral squamous lung cancer.The clinical and histological features of the disease resembled the pneumoconioses of coalminers and kaolin workers and the lungs of three of the patients were shown to contain dust composed predominantly of kaolinite, mica, and silica. Shale miners' complicated pneumoconiosis has not previously been described. Although the British shale industry is now defunct, oil production from shale is expanding in other countries, notably the USA. It is suggested that control should be exercised over dust exposure levels in this industry and that epidemiological studies should be carried out to quantify the risks of both pneumoconiosis and bronchial carcinoma.
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